CERTIFICATE FROM THE CANDIDATE
This is to certify that the project on “A Study to assess Patient’s Satisfaction with Quality of Nursing Care”, is a genuine work done by me, under the guidance of Dr. Saramma PP, PhD, Senior Lecturer in Nursing, SCTIMST, Trivandrum. It is also certified that this work has not been presented to any other university for award of degree, diploma or other recognition.
Thiruvananthapuram
Mrs. RAJESWARI. T
November 2011
Code No.6207 SCTIMST Trivandrum
iii
APPROVAL SHEET
This is certify that Mrs.Rajeswari.T bearing code no 6207 have been admitted to the Diploma in Neuro Nursing in January 2011 and she has undertaken the project entitled “A Study to assess Patient’s Satisfaction with Quality of Nursing care”, which is approved for the diploma in Neuro Nursing awarded by Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, and is found satisfactory.
Place:
Examiners
Date: (1)__________________
(2) __________________
Guide
(1) __________________
(2) __________________
iv
ACKNOWLEDGEMENT First of all let me thank God almighty for unending love, care and blessing especially during the tenure of this study.
The present study has been completed under the expert guidance of Dr. Saramma PP, Senior Lecturer in Nursing, SCTIMST, Trivandrum. Investigator expresses her sincere gratitude to Dr. Saramma PP, for the valuable guidance, constant support and encouragement given from the inception to the completion of the study.
The researcher expresses her sincere thanks to Dr.Radhakrishnan K Director, SCTIMST, Trivandrum, for giving this opportunity for conducting this study. The researcher greatly values the favor extended by Mrs. Sujaraj Msc (N) and Mrs. Jissa VT scientist B, AMC,SCTIMST for the guidance and constant support, and sincere thanks to all staffs in NMICU and NM WARD for their constant support.
Investigator also likes to acknowledge the contribution of all participants who kindly agreed to take part in the study. The generously gave their time and attention to the research. This would have been impossible without such generosity. A word of sincere thanks to all staff of Library SCTIMST, for their co-operation and help.
v
ABSTRACT Objectives: - (i) To assess the patient satisfaction with quality of `nursing Care. (ii)To identify relationship between satisfaction of patient with selected variables. Method:-In this study descriptive survey approach was used. Purposive sampling technique is used and study sample was 50 adult patients who admitted in the NMICU and NM ward of SCTIMST. The total period of sample collection was from September 2011 to October 2011.The data collection tool used for the study was a modified form of Dr. Laschinger’s“Patient satisfaction with quality nursing care questionnaire” [PSNCQQ], translated to vernacular language Malayalam.
Result:-The total number of sample was 50. The mean age of sample was 44.7 yrs. Majority of the samples 70% were reported good, 30% were reported excellent and no one reported poor. In this study there is no significant relation between patient satisfaction with quality of nursing care by different variables.
vi
CONTENTS
Sl. No 1
Title
Page No.
INTRODUCTION
15-19
1.1
Introduction
15-16
1.2
Background of the study
16-17
1.3
Need and significance
17-18
1.4
Statement of problem
18
1.5
Objectives
18
1.6
Operational definition
18
1.7
Methodology
1.8
Tool
19
1.9
Delimitation
19
1.10
Organization of report
19
II
Review Of Literature
20-29
18-19
2.1
Introduction
20
2.2
Studies on patient satisfaction with nursing care.
21-24
2.3
Studies on quality of nursing care
24-27
vii
Sl. No
Title
Page No.
2.4
Studies on factors influencing patient’s satisfaction
27-29
with nursing care. 2.5
Summary
29
111
METHODOLOGY
3.1
Introduction
30
3.2
Research approach
30
3.3
Research design
30
3.4
Setting of the study
30
3.5
Study population
31
3.6
Sample size
31
3.7
Criteria for sample collection
31
3.8
Sampling technique
31
3.9
Data collection tool
31
3.10
Description of the tool
3.11
Pilot study
32
3.12
Data collection procedure
32
3.13
Plan of analysis
32
30-32
31-32
viii
Sl. No 3.14
Title Summary
32
IV
ANALYSIS AND INTERPRETATION
4.1
Introduction
4.2
Distribution of sample according to
4.3
Page No.
33-60 33
demographic variables
34-41
Distribution of sample based on criteria information
42-49
given by nurses 4.4
Distribution of sample based on quality of nursing
50-57
care 4.5
Overall Patient satisfaction with nursing care
4.6
Summary
V
SUMMARY,
58-60 60
CONCLUSION,DISCUSSION
AND
61-63
RECOMMANDATION 5.1
Introduction
61
5.2
Summary
61
5.3
Objectives of the study
61
5.4
Limitation
61
5.5
Major findings of the study
62
5.6
Recommendation
62
ix
Sl. No
Title
Page No.
5.7
Discussion
62-63
5.8
Conclusion
63
VI
REFERENCES
Vll
INFORMED CONSENT
Vlll
TOOL
64-66 67 68-71
x
LIST OF TABLES Table
Titles
Page No.
4.2 a
Distribution of sample by age
34
4.2 b
Distribution of sample by sex
35
4.2 c
Distribution of sample by marital status
36
4.2d
Distribution of sample by education
37
4.2e
Distribution of sample by category
38
4.2f
Distribution of sample according to length of
39
hospital stay 4.2g
Distribution of sample according to previous
40
admission 4.2 h
Distribution of sample according to diagnosis
41
4.3a
Distribution of sample by criteria information given
42
by nurses 4.3b
Distribution
of
sample
based
on
patients’
43
satisfaction about information given by nurses and age group. 4.3c
Distribution
of
sample
based
on
patients’
44
satisfaction about information given by nurses and sex 4.3d
Distribution
of
sample
based
on
patients’
satisfaction about information given by nurses and
xi
45
Table
Titles
Page No.
marital status 4.3e
Distribution
of
sample
patients’
based
on
46
satisfaction about information given by nurses status 4.3f
Distribution
of
sample
patients’ based
on
47
satisfaction about information given by nurses and category 4.3g
Distribution
of
sample
based
on
patients’
48
satisfaction about information given by nurses and length of hospital stay 4.3h
Distribution
of
sample
based
on
patients’
49
satisfaction about information given by nurses and previous admission 4.4a
Distribution of sample based on quality of nursing
50
care 4.4b
Distribution of sample based on quality of nursing
51
care and age 4.4c
Distribution of sample based on quality of nursing
52
care and sex 4.4d
Distribution of sample based on quality of nursing
53
care and marital status 4.4e
Distribution of sample based on quality of nursing care and educational status
xii
54
Table
Titles
Page No.
4.4f
Distribution of sample based on quality of nursing
55
care and category 4.4g
Distribution of sample based on quality of nursing
56
care and length of stay 4.4h
Distribution of sample based on quality of nursing
57
care and previous admission 4.5 a
Distribution of sample based on overall patient
58
satisfaction with quality of nursing care 4.5b
Association with overall patient satisfaction with quality of nursing care by different variables
xiii
59-60
LIST OF FIGURES
Fig
Titles
Page No.
4.2a
Bar diagram of sample according to age
34
4.2b
Pie diagram of sample according to l sex
35
4.2c
Pie diagram of sample according to marital
36
status 4.2d
Bar
diagram
of
sample
according
to
37
4.2e
Bar diagram of sample according to category
38
4.2f
Pie diagram of sample according to length of
39
education
stay 4.2g
Pie diagram of sample according to previous
40
admission 4.2h
Bar
diagram
of
sample
according
to
41
Bar diagram of sample based on information
42
diagnosis 4.3a
given by nurses 4.3b
Bar diagram of sample based on patients’ satisfaction
about
information
nurses and age group
xiv
given
by
43
Fig
Titles
Page No.
4.3c
Bar diagram of sample based on patients’
44
satisfaction
about
information
given
by
nurses and sex 4.3d
Bar diagram of sample based on patients’ satisfaction
about
information
given
45
by
nurses and marital status 4.3e
Bar diagram of sample based on patients’ satisfaction
about
information
given
46
by
nurses and education Bar diagram of sample based on patients’ 4.3f
satisfaction
about
information
given
47
by
nurses and category 4.3g
Bar diagram of sample based on patients’ satisfaction
about
information
given
48
by
nurses and length of stay 4.3h
Bar diagram of sample based on patients’ satisfaction
about
information
given
49
by
nurses and previous admission 4.4a
Pie diagram of sample based on quality of
50
nursing care 4.4b
Bar diagram of sample based on quality of nursing care and age
xv
51
Fig
Titles
Page No.
4.4c
Bar diagram of sample based on quality of
52
nursing care according to sex 4.4d
Bar diagram of sample by quality of nursing
53
care according to marital status 4.4e
Bar diagram of sample by quality of nursing
54
care according to education 4.4f
Bar diagram of sample by quality of nursing
55
care and category 4.4g
Bar diagram of sample based on quality of
56
nursing care and length of hospital stay 4.4h
Bar diagram of sample based on quality of
57
nursing care and previous admission 4.5
Pie diagram of sample based on overall patient satisfaction with nursing care
xvi
58
Chapter - I INTRODUCTION 1.1 Introduction Patient satisfaction has become increasingly popular, as a critical component in the measurement of quality of care. Satisfaction is one of the cares out come for healthcare. Satisfaction with health care is measure with a long history in the social science. Nursing service is one of the most important components of hospital service. Understanding how things are looking through the patient ‟s eye should be central part of quality improvement. The level of patient satisfaction with nursing care is an important indicator of quality of care provided in hospitals [Laschinger et al., 2005]. Patient satisfaction is a term that can be interpreted differently by patients and it meaning can also differ for one patient at different times. Patient‟s satisfaction some time treated as an outcome measure of healthcare providers. A satisfied patient is more willing to recommend the hospital to provide his or her care to others. [Abramowitz et al., 1987] Patient places high value on the interpersonal care provided by the nursing staff. Consumers of health care industry demand quality care and one measure of quality is patient‟s satisfaction. Patient‟s satisfaction is an indicator of quality of care from patient‟s perspective. Patient‟s satisfaction is defined as patient‟s subjective evaluation of their cognitive and emotional reaction as a result of interaction between their expectation regarding ideal nursing care and their perceptions of actual nursing care [Erikson1987].
Definition of nursing care is to promote health and to help support, educate and develop patient by liberating his or her own resources. The nursing care provided by nurse is regarded as most important factor in patient assessment of their satisfaction with health care. If patient is satisfied with health care received,
this is positive not only for individual but also for nurse and entire health care organization (Johansson et al; 2002)
1.2 Background of the study Nursing is a career, which calls for certain special qualities. Florence Nightingale is considered as the founder of modern nursing. She mentioned in her notes on nursing about the characteristics of a nurse. She says “A nurse must be no gossip, no vain talker is strictly sober and honest; but more than this, she must be devoted woman, she must have respect for her calling, she must be a sound, a close and a quick observer, and she must be a woman of delicate and decent feeling”.
According to the American Nurses Association, “Nursing practice is a direct service, goal directed and adaptable to the needs of the individual, the family and community during health and illness. The nurse‟s primary responsibility is to those people who require nursing care.
Instruments measuring patient‟s satisfaction have often been focused on in patient treatment [Muntlin et al., 2006]. Nursing care has a prominent role in patient satisfaction, patient satisfaction is an important indicator of quality of care and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in healthcare market [Wagner et al., 2009].The main indication for measuring patient satisfaction with nursing care is to identify area for improvement.
During hospitalization patient‟s satisfaction represents a balance between patient‟s perception and exceptions of their nursing care. Patient‟s satisfaction is important patient-centered out come to measure, is accepted as standard measure of quality of care and it is steadily gaining in popularity.
Today‟s nurse engages in approximately eight inter related roles: -care giver, advocate, critical thinker, teacher, communicator, manager, researcher & rehabilitator [Harkreader and Hogan2004]. Patient satisfaction with nursing care has consistently been found to be correlated with overall satisfaction care and has
2
been defined as the patient subjective evaluation of 3the cognitive and emotional response that result from interaction the patient‟s expectation of nursing care and their perception of actual nurse behavior and characteristics [Erickson.,1987].
Nursing is a process of recognizing; understanding and meeting health needs of any person or society and is based on constantly changing the body of scientific knowledge. Nurses and physicians perceptions about good quality of care do not always agree with patient‟s perceptions. Nursing is an accountable profession guided by science, theory, code of ethics and the art of care and comfort to treat human responses to health and ill Patient‟s satisfaction with nursing care is considered as an important factor in explaining patient‟s perception of service quality.
The nurse work environment has being found to be both directly and indirectly related to patient‟s satisfaction [Vahey. 2004]. Patient‟s satisfaction has been advocated as an outcome measure of quality nursing care. Determinants quality of nursing care include: adequate skill, caring attitudes, effective communication, efficient organizational and management systems, and effective participation.
1. 2 Need and significance of the study Nursing care is recognized as an area subjected to competition, where the patient is seen both as a client and consumer of health care. To improve quality of nursing care, nurses need to know what factors influence patient satisfaction. Nursing care plays the key role in providing satisfaction in this arena. Quality of nursing care is vital to patient out comes and safety. Patient satisfaction with nursing care is strongly associated with patients overall satisfaction with hospital experience. To ensure service improvement initiatives at appropriative levels in hospital is a prerequisite to understand factors which influence patient satisfaction with nursing care. The measurement of patient satisfaction with nursing care is important to determine and meet patient‟s need in terms of care and to evaluate quality of care provided.
3
Patients in the neuromedical unit needs prolonged hospital stay. Prolonged hospital stay itself can cause health care associated infections, psychological stress and complication like bed sore, hydrostatic pneumonia etc. So nurse should focus giving in holistic care to the patient in order to prevent or limit the complication and for easy recovery. So assessing patient satisfaction can bring new changes in approach or modification in nursing care.
1.4 Statement of the problem A study to assess patient satisfaction with quality of nursing care in neuromedical department, Sree Chitra Tirunal Institute for Medical sciences and Technology.
1.5 Objectives of the study 1. To assess the patient satisfaction with quality of nursing care. 2. To identify relationship between satisfaction of patient with selected variables.
1.6 Operational definitions Patient satisfaction - The degree to which the individual perceives health care service provided by nurses in selected department as useful, effective or beneficial as measured by using Patient Satisfaction With Nursing Care Quality Questionnaire [PSNCQQ].
Quality of nursing care - It refers to meeting the health care needs of patients with regards to caring attitude of nurses, effective communication, proper explanations before procedures and treatment, adequate skill and competence, effective participation, organizational and management systems and involvement of patient and significant others in care.
Neuromedical department - It refers to neuromedical ICU and neuromedical ward in Sree Chitra Tirunal Institute for Medical Sciences and Technology.
4
1.7 Methodology Study settings
: Neuromedical ICU and Neuromedical Ward in SCTIMST.
Study approach
: Descriptive Survey approach is used for present the study.
Sample technique
: onsecutive/ purposive sampling.
Inclusion criteria
: Patients who can read and understand Malayalam, patients
who are fully awake and willing to participate.
1.8 Tool A modified form of Dr. Laschinger‟s- “Patient satisfaction with quality nursing care questionnaire” [PSNCQQ], translated to vernacular language Malayalam. 1.9 Delimitation The study is delimited to patients in neuromedical ward and neuromedical ICU in SCTIMST and patients above 18 years of age. 1.10 Organization of report This chapter deals with introduction, background of the study, need and significance of the study, statement of the problem, objective, operational definitions, methodology and delimitations. Chapter 2 deals with review of literature. Chapter 3 deals with methodology. Chapter 4 deals with analysis and interpretation of
data.
Chapter
5
includes
summary,
discussion,
conclusion
recommendations. References and appendixes are given towards the end.
5
and
Chapter - II
REVIEW OF LITERATURE
2.1 Introduction Review of literature serves an important function in the research process. It is the critical summary of research on the topic of interest often prepared to put a research problem in context. Literature review helps to lay the foundation for a study and also and can also inspire new research ideas. It gives character insight into the problem and help in selecting methodology, developing tool and also analyzing data. With these in view an intensive review of literature has been done.
The review of literature relevant to this study is presented in the following sections.
2.2 Studies on patients‟ satisfaction with nursing care. 2.3 Studies on quality of nursing care. 2.4 Studies on factors influencing patient‟s satisfaction with nursing care.
2.2 Studies on patient satisfaction with nursing care Findik et al., (2010) conducted a cross sectional study in a 1100 bed hospital in Turkey The aim of the study was to assess patient satisfaction with nursing care and relationship between patient characteristics. The study was conducted between February and September 2006 within 12 different services in the Hospital, each with a 20-25 bed capacity and 6-7 nurses. Seven internal medicine wards and 5 surgical wards were included in the study. Two-hundred-andtwenty-nine adult patients (98 surgical, 131 medical) recruited to the study. The participants who were eligible for recruitment were patients of at least 18 years of age who had been hospitalized for at least 2 days were due to be discharged. Data were collected using the Newcastle satisfaction with nursing care scale and a patient information form. Overall data indicated a high level of patient satisfaction. Hospitalization affected the Experience of Nursing Care Scale independently, while the type of ward, sex, income, and education independently affected the satisfaction with Nursing Care Scale. Patient who underwent surgical procedures,
6
male patients, the 40-59 year old age group those who had low levels of education or income, and patients who were hospitalized for longer periods were most satisfied. Patients age, sex, income, ward type were important factors that affected their satisfaction with nursing care.
Wagner [2009] conducted a study on patient satisfaction with nursing care using a nursing model to measure patient satisfaction with nursing and clarify this concept. The aim of the study was a concept analysis of patient satisfaction with nursing care. Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The sample included 44 papers published in English, between 1998 and 2007.Cox's Interaction Model of Client Health Behavior was used to analyses the concept of patient satisfaction with nursing care. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.
Laschinger et al; [2005] conducted a study on a psychometric analysis of patient satisfaction with nursing care quality questionnaire; An actionable approach to measuring satisfaction. Patient satisfaction with nursing care quality is an important indicator of quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality with in a random sample of 14 hospitals in Ontario, Canada. PSNCQQ consist of 23 questions, the satisfaction level assessed in terms of whether they are Excellent, Very good, Good, Fair or Poor. Result of this study revealed that the newly developed instrument had excellent psychometric properties. Total score on satisfaction with nursing care were strongly related to overall satisfaction with quality of care received during hospitalization. The result of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement.
7
Yildirim et al (2005) identified the factors associated with Patient satisfaction and dissatisfaction and decided the demographic characteristics. The study was carried out from January 1 to June 31, 2001. The adult Patient who consecutively presented to the emergency department between 8 am to 5 pm and stayed more than 24 hours were included in the study. Patients were asked to complete a questionnaire prior to discharge. The questionnaire was about attitude, Politeness and efficiency of medical and auxiliary staff. 249 patients were included in the study. Research concluded that, 45% of the patients preferred emergency department because of previous perception of higher quality care. The major cause of dissatisfaction was lengthy waiting time (27%).
Fahad [2005] conducted a survey study of a random sample of 420 patient to determine the extent of patient satisfaction with care provided at the 110 bed hospital at all levels and to correlate patients‟ satisfaction with nursing care, in particular, with their overall satisfaction and to assess the predictive value of patient satisfaction on subsequent return to the hospital. Study period was January 1March 31, 2004. The extent of overall patient satisfaction with the quality of care provided at the hospital was found to be quite high (Excellent, 74.7%; Very good, 23.7%). Individually, nursing care received the maximum patient satisfaction ratings (Excellent, 91.9%; Very good, 3.9%). A positive correlation (r = 0.31, P = .01) was noted between patients‟ perception of nursing care and their overall satisfaction with the health care provided at the hospital. Significant positive correlation (r = 0.36, P = .01) was also found between overall patient satisfaction and their reported intentions of returning and recommending the hospital to others. Overall patient satisfaction is linked with quality nursing care, which, in turn, depends on the quality of leadership practiced at the institution.
Johansson et al., [2002] conducted a literature study on patient satisfaction with nursing care in the context of health care. The aim of this study was to describe the influence on patient satisfaction with regard to nursing care in the context of health care. In the description of nursing care, researcher used Hendersons nursing care model. The literature search was carried out using MEDLINE and CINAHL database. The following search words used client satisfaction, patient satisfaction, quality of care, quality indicators and quality of
8
nursing care.30 studies, published between 1987&1999 were found. The results describe eight domains that have an influence on patient satisfaction with nursing care; the socio-demographic background of the patients, patients expectations regarding nursing care, the physical environment, communication and information, participation and involvement, interpersonal relations between nurse and patient, nurses medical technical competence, and the influence of the health care organization on both patients and nurses. An important implication for future research is to elucidate the factors that influence satisfaction with nursing care, as seen from the Patients perspective.
O‟ Connel et al., [2002] conducted a descriptive study on patient satisfaction with nursing care in two acute care surgical wards, using a revised 28- item La Monica- Oberst patient satisfaction scale and telephone interviews. The questionnaire consists of 28 items that comprised 3 subscales that measured interpersonal support [9] questions, on good impression [5] questions, on dissatisfaction [14] questions with nursing care. A 5- point Likert scale ranging from strongly disagree [1], to neutral, to strongly agree [5] was used. The objective of the study was to evaluate patient satisfaction with nursing care in two matched surgical wards. The study population consists of all patients aged 18 years and over and patients were surveyed and interviewed over a 12-week period. The final sample consists of 105 patients. The findings of quantitative and qualitative data were compared in order to determine similarities and differences. Total satisfaction score ranges from 32-140. Mean satisfaction score [115]. Standard deviation [17.41]. Survey results reveal high levels of patient satisfaction, qualitative data revealed some anomalies. Within this study the patient perception of nurses influenced the way the patient rated quality of nursing care.
2.3Studies on quality of nursing care Lindgren et al., [2011] conducted a prospective study on the Karen instruments for measuring quality of nursing care in medical and surgical wards at a hospital in Sweden. The objective of this study was to further develop the instruments with regard to construct validity and internal consistency, the Karenpatient and the Karen-personnel based on Donabedian's Structure –Process –
9
Outcome triad (S –P –O triad) had promising content validity, discriminative power and internal consistency. A total of 95 patients and 120 personnel were included,95 patients of whom 47 were women. The mean age was 64.4 ±15.8 years, with a range of 22 –86. The mean length of hospitalization was 9.1 ±13.4 days, with a range of 3 –105. Forty of the patients had previously been treated in the same ward. There were 120 participants in the personnel group, of whom 111 were women and 9 were men. The personnel group consisted of 61 registered nurses and 59 nursing aids. The mean age was 43.6 ±8.3 with a range between 27 and 60 years. The Karen-patient and the Karen-personnel instruments have achieved acceptable levels of construct validity. The internal consistency of the instruments is good. This indicates that the instruments may be suitable to use in clinical practice for measuring the quality of nursing care.
Ijeoma et al., [2011] conducted a descriptive study was to determine helpless patients‟ satisfaction with quality of care received at tertiary hospitals in Enugu in Nigeria. Total populations of 105 helpless patients, those that need assistance with the activities of daily living were studied. Tools for data collection were questionnaire and interview guide. Data were analyzed using descriptive statistics. Results showed that helpless patients were satisfied with physical and psychological care but satisfaction with spiritual care was marginal. Nurses seemed to lack skills for meeting spiritual needs of the patients. Patients‟ satisfaction with nurses‟ attitude was marginally positive. The study showed that th ere was need for improvement in the care nurses provide for helpless patients in the spiritual dimension.
Lucero et al.,[2010] Conducted a study on Nursing care quality and adverse events in US hospitals, to examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. T he proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. The adverse events
10
occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event.
Lynn et al., [2007] conducted a study on Understanding and measuring patients' assessment of the quality of nursing care. The objective of the study was to develop the Patient's Assessment of Quality Scale--Acute Care Version (PAQS ACV) to provide a mechanism through which patients can evaluate meaningfully the nursing care they receive. Methods of the study developed from qualitative interviews with patients, the original 90-item PAQS-ACV was tested with 1,470 medical surgical patients in 43 units across seven hospitals. The typical patient was a married, 50-year-old, high school-educated patient hospitalized for the fourth time. Every 10th patient was asked to complete the PAQS-ACV 2 weeks later. After exploratory factor analysis, 45 items remained in five f actors, accounting for 54% of the variance. Internal consistency estimates were above 0.83 for four of the five factors, with the fifth factor being0.68. Test-retest reliability ranged from 0.58 to 0.71. Content validity was established and construct validity has been explored preliminarily by examining the relationship between the PAQS-ACV scores and patients' compliance. The PAQS-ACV is a relatively new measure of quality nursing care; it has met many criteria for an adequate measure of quality care.
Mrayyan et al., [2006] conducted a descriptive cross-sectional comparative design to assess Jordanian nurses‟ job satisfaction, patients‟ satisfaction and quality of nursing care. The total populations were: 200 nurses (response rate 60%), 510 patients (response rate 49%), and 26 head nurses (NHs) (response rate 92%). Mueller/McCloskey Satisfaction Scale (MMSS) 1990; Eriksen‟s (1988) scale of The Satisfaction with Nursing Care; and Quality of Nursing Care QuestionnaireHead Nurse of Safford & Schlotfeldt (1960) were used to measure the phenomena of interest. Nurses were „neither satisfied nor dissatisfied‟ in their jobs, nurses who work in wards reported a slightly better job satisfaction than nurses who work in critical care units. Patients reported that they were „moderately‟ satisfied, and head nurses reported that nurses „usually (practically)‟ provide a high quality of nursing care. There were no significant differences between critical care units and wards with regard to patients‟ satisfaction and quality of nursing care. Patients‟ satisfaction
11
and quality of nursing care have to be enhanced to reach the levels of „very satisfied‟ and „always‟ consecutively.
Muntlin et al., [2006] conducted a prospective, descriptive survey, to identify patient's perceptions of quality of care at an emergency department and areas for quality improvement. Study design was adopted and the study took place in one emergency department at a Swedish university hospital in 2002. The participants were 99 women and 101 men, with an average age of 51 years. The emergency department version of the questionnaire Quality from the Patient's Perspective was used for data collection. The result of the study was patients estimated quality of care at the emergency department as fairly good, but there were areas in need of improvement. A high percent of inadequate quality was related to the environment in the emergency department. About 20% of patients reported that they did not receive effective pain relief. More than 20% estimated that nurses did not show an interest in their life situation and patients did not receive useful information on selfcare and about which physician was responsible for their medical care.
Uys et al., [2004] conducted a study on a Survey of the quality of nursing care in three health districts in South Africa from March to August 2002. The purpose of this study was to describe and compare the quality of nursing service and care in three health districts in the KwaZulu Natal Province. Five different aspects of care was evaluated; hand-over from one nursing shift to another, implementation of universal precautions, patient satisfaction, nursing records, management of chronic illnesses. All these aspects were evaluated using checklists based on record reviews or direct observation, except for patient satisfaction, which was evaluated by questionnaires. The average scores on the different aspects varied from 11% (for nursing records) to 73% (for management of chronic diseases). Specific problems became evident. In one district three out of four handover between shifts of nurses scored less than 50%. In all three districts the use of protective gear scored low (43%). While the average score for management of chronic illnesses were high at 73%, the blood pressures of only 23% was within the target range, and the blood sugar of only 38% of patients were controlled. Patient satisfaction averaged 72% across the three districts. The quality of care measurements identified specific training needs, but other management strategies are probably also indicated.
12
2.4 Studies on factors influencing patient satisfaction with nursing care Yim et al., [2008] conducted a study on Evaluation of the satisfaction and usefulness of a web-based educational program for breast cancer patients to evaluate the effectiveness of a web-based breast cancer educational program which consists of special features such as flash animations and online counseling as well as 7 different categories of information on breast cancer. A total of 147 women with breast cancer who visited the website for at least 30 minutes and a minimum of 3 visits, participated in the survey. In this educational program, usefulness of information, system efficiency, adequacy of information and convenience of use all received positive evaluation and showed even distribution of 49.14 (+/-6.05) points out of 64 points total. In the usefulness evaluation, the subcategories had following scores from the highest to the lowest; understanding of breast cancer was 3.34 (+/-0.51), life after treatment (3.21+/-0.58), early detection and examination (3.20+/-0.60), chemotherapy and hormonal therapy (3.18+/-0.55), related factors and prevention (3.16+/-0.59), treatments (3.13+/-0.53), and diagnosis (3.02+/-0.56). Factors affecting the satisfaction of the program were age, religion, income, stage of disease at diagnosis, source of health information, duration of Internet usage, and whether the patient performs breast selfexamination. Although the program was evaluated as somewhat useful and satisfactory, it should be improved upon by providing in-depth and cutting edge breast health information especially for women from a higher educational and income background.
Chang et al., [2003] conducted a study on the influence of demographic variables and ward type on elderly patients‟ perceptions of needs and satisfaction during
acute
hospitalization.
The
study
designed
to
determine
whether
demographic characteristics of patients such as age, gender and cultural background were associated with different perceptions of the importance of and satisfaction with various aspects of nursing care. Patients were selected from geriatric and medical wards at five hospitals in the Sydney area. Five hundred and seventy-six patients were ineligible due to dementia, confusion or mental illness. Two hundred and thirty-one subjects out of 393 who were invited to participate consented (59%). Only 3% of potential participants did not consent because they
13
did not wish to participate. 40% (n = 90) of patients were male, 63% (n = 146) were aged 65 –80 years, with the remainder (n = 85) over 80 years. Two-thirds (n = 153) were from medical wards with the remainder from aged care wards (n = 78), while 87% (n = 204) were of English-speaking background (ESB) A mean score was calculated for each of the four categories (physical, psychosocial, doctors‟ orders, discharge planning). Data were analyzed using repeated measures analysis of variance (ANOVA) to determine group differences on the four categories combined from the CAS Results demonstrated that patients who were older (aged > 80 years), female and from aged care wards perceived that physical aspects of nursing care were more important than did patients who were younger (aged 65 –80 years), male and from medical wards. Older patients and those from aged care wards were more satisfied with physical care.
Foss [ 2002] conducted a study on Gender-related difference in patient satisfaction with quality of nursing care. To conduct the study researcher was using data from a Norwegian survey of patient-satisfaction. The survey included 1469 male and 1226 female patients. Results showed that young female patients were less content with all aspects of nursing care when compared with young male patients. The RESKVA study is a Norwegian survey of in-patient satisfaction, conducted by The Foundation of Health Services Research (HELTEF) from 1995 to 1998. The patient satisfaction questionnaire consisted of 39 questions (24). Thirtyfour of the 39 questions had five response options, where the two extremes were specified (completely content – complete discontent). Six of the questions related to patient's experiences with nursing care. The total data set included 19,395 patients from two different Norwegian hospitals. The remaining data consisted of replies from 2695 respondents. There were 1469 male and 1226 female patients. The overall response rate was 59%. Mean score of satisfaction with the different areas of quality of nursing care (all ages) the following levels of significance; personal commitment = 0.003, caring behavior = 0.001, time to talk = 0.004, time to help = 0.000, nursing skills = 0.006. The patients' experiences with the continuity of care did not show significant gender difference (p = 0.117). No significant differences were found between the sexes in mean age in any of the three groups. Mean scores were used when presenting the patients' level of satisfaction; score 1 representing the lowest – and score 5 the highest possible level of satisfaction.
14
Comparison of male and female patient‟s means scores were performed using ttest.
2.5 Summary From the literature reviewed, it is evident that many factors influence patient satisfaction with quality of nursing care like age, gender difference etc.
15
Chapter - III RESEARCH METHODOLOGY 3.1 Introduction Research methodology is the systematic way to solve research problem. It include the step that researcher adopt to study this problem with the logic behind. It indicates the general pattern of organizing the procedure of gathering valid and reliable data for an investigation.
This chapter provides a brief description of method adopted by the investigator to conduct the study. This chapter includes research approach, research design, and setting of the study, sample and sampling technique. It f urther deals with development of tool, procedure for data collection, and for data analysis.
3.2 Research approach Survey approach is used for the present study. Survey approach is more useful in educational fact finding, in relatively small samples.
3.3 Research design The descriptive study design was used to fulfill the objective of the study.
3.4 Setting of the study This study was conducted in neuromedical ICU and NM ward of Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram. The rational for selecting this institute for the study was that the researcher was more familiar with this institution. SCTIMST is an institute of national importance where there is a separate wing for neuromedical unit.
3.5 Study population The target population of the study was both male and female patients admitted in neuromedical unit in SCTIMST.
16
3.6 Sample size The sample size consists of 50 patients. 10 patients were selected for pilot study.
3.7 Criteria for sample selection Inclusion criteria: - Patients who are willing to participate - Patients who can read and understand Malayalam - Patients who are for discharge on the day of data collection. - Patients who have age above 18 years.
Exclusion criteria - Patients on ventilator - Patients who do not respond/ disoriented/altered mental status
3.8 Sampling technique Patients who are in neuromedical unit during data collection period and who fulfilled inclusion criteria were collected as samples by convenient sampling technique.
3.9 Data collection tool Data collection tool refers to instrument which was used by investigator to obtain relevant data. A modified questionnaire was prepared by investigator from Dr. Laschingers. The questionnaire was translated t o regional language Malayalam with some modifications. The tool was examined by experts of SCTIMST. The research tool was finalized according to expert‟s opinion. . 3.10 Description of the tool Laschinger et al [2005] prepared PSNCQQ; the questionnaire was five paint rating scale consisting of nursing care during hospital stay.
The rating scales were - excellent, very good, good, fair, and poor
17
The questionnaire was translated to regional language Malayalam with some modification.
The structured questionnaire consists of two sections.
General information or demographic data, it includes Name, age, sex, marital status, education, category, date of admission, number of previous admission, way of admission and diagnosis
20 questions regarding patient satisfaction with nursing care. The options given for rating were: excellent, very good, good, fair and poor.
3.11 Pilot study A pilot study was conducted from 5/9/2011 to 8/9/2011.The aim of the pilot study was to find out the feasibility and practicability of the tool. The study was conducted among 10 samples; the sampling technique used was convenient sampling informed consent was taking from the samples. The finalized tool was used to assess patient satisfaction with nursing care quality questionnaire. The pilot study finding revealed that the study was feasible and practicable.
3.12 Data collection procedure There was no problem faced during pilot study, the same method of data collection was used for the final study. The researcher first introduced herself to the patient and explained the need and purpose of the study. Informed consent was taken from the patient before data collection. It took 20 minutes for the patient to answering the questions
3.13 Plan of analysis. A plan for data analysis was developed by the investigator after the data collection. The data obtained from satisfaction questionnaire would be analyzed by descriptive statistics. Percentages would be used for describing the sample. In this study there are 20 questions. These questions are grouped into 2 major categories; they are information given by nurses and quality of nursing care. In the questionnaire question no.1,2,3,4,5,6,10,18 belongs to information given by nurses
18
and question no.7,8,9,11,12,13,14,15,16,17,19,20 belongs to quality of nursing care.
3.14 Summary This chapter presented the research approach used for present the study, research design of the study, setting of the study, study population, sample size, criteria for sample selection, sampling technique, description of tool, pilot study, data collection procedure and plan of analysis.
19
Chapter - IV ANALYSIS AND INTERPRETATION OF DATA 4.1 Introduction Analysis is categorizing, ordering manipulating and summarizing the data to an intelligible and interpretable form so that the research problem can be studied and tested including relationship between variables.
Interpretation is the process of making the sense of results and the examining the implication of the findings with in a broad context.
The data‟s in this study analyzed and arranged under following sections
4.2.
Distribution of samples according to demographic variables.
4.3.
Distribution of samples according to information given by nurses.
4.4.
Distribution of samples according to quality of nursing care.
4.5.
Distribution of sample based on association of overall satisfaction with nursing care and selected variables.
20
4.2 Distribution of samples according to demographic variable
Table 4.2 a. Distribution of sample by age
Age Group
Frequency
Percentage (%)
<20
3
6
21-30
10
20
31-40
7
14
41-50
12
24
51-60
6
12
61-70
8
16
71-80
4
8
Total
50
100
Table 4.2 a. shows distribution of sample by age. The age of sample ranges from18-78 with a mean age of 44.7, standard deviation 16.88, majority of samples were from age group 41-50 and only 6% were from age group <20 AGE
15 12
10 10 5
7 3
6
8 4
frequency
0
4.2a Bar diagram showing distribution of sample according to age.
21
4.2 b Distribution of sample according to sex
Table 4.2 b shows distribution of sample according to sex.
Sex
Frequency
Percentage
Male
33
66
Female
17
34
Total
50
100
Table 4.2 b shows distribution of sample according to sex. There majority of sample were male (66%) and only (34%) in female sample.
SEX
frequency male
female
34%
66%
4.2 b Pie diagram of sample according to sex
22
4.2 c Distribution of sample according to marital status
Table 4.2 c Distribution of sample by marital status
Marital status
Frequency
Percentage
Single
9
18
Married
41
82
Total
50
100
Table 4.2c shows that distribution of sample by marital status. Majority of sample were married (82%). 41(82%) were married and 9 (18%) were single.
MARITAL STATUS
frequency
single 18%
married 82%
4.2c Pie diagram of sample according to marital status
23
4.2 d Distribution of sample according to education
4.2 d Distribution of sample according to education
Education
Frequency
Percentage
School
25
50
Pus two
12
24
Graduate
10
20
Post graduate
3
6
Total
50
100
Table 4.2 (d) shows that the majority of sample had school education (50%), only 6% percentage had post graduate education. The same data is shown in the Fig 4.2d
frequency 25 20 15 frequency
10 5 0 school
plus two
graduate
post graduate
4.2 d Bar diagram of sample according to education
24
4.2 e Distribution of sample according to income category
Table 4.2 ( e) shows distribution of sample according to category
Category
Frequency
Percentage
A
3
6
B1
9
18
B
8
16
C
3
6
D
27
54
Total
50
100
Table 4.2 (e) shows that majority of samples (54%) were D category, only (6%) were A category and (6%) were C category.
CATEGORY
frequency 30 20 10
frequency
0 A
B1
B
C
D
4.2 e Bar diagram of sample according to category
25
4.2 (f) Distribution of sample according to length of hospital stay
Table 4.2 (f) Distribution of sample according to length of hospital stay
Length of stay in days
Frequency
Percentage
≤10 days
38
76
>10 days
12
24
Total
50
100
Table 4.2 (f) shows that majority of sample 41(82%) stay <=10 day, only 9(18%) were more than 10 days.
LENGTH OF HOSPITAL STAY
frequency ≤10
>10
24%
76%
4.2(f) Pie diagram of sample according to length of hospital stay
26
4.2(g) Distribution of sample according to previous admission
Table 4.2(g) Distribution of sample according to previous admission
Previous admission
Frequency
Percentage
Yes
36
72
No
14
28
Total
50
100
4.2(g) Distribution of sample according to previous admission.36 (72%) patients were previously admitted and 14(28%) patients not previously admitted. The same data shown in Fig 4.2(g)
PREVIOUS ADMISSION
frequency
no 28%
yes 72%
4.2(g) Pie diagram of sample according to previous admission
27
4.2 h Distribution of sample according to diagnosis
Table 4.2h Distribution of sample according to diagnosis
Diagnosis
Frequency
Percentage
Myasthenia gravis
9
18
Vasculitis
2
4
Multiple sclerosis
6
12
Tb meningitis
2
4
Encephalitis
31
62
Total
50
100
The diagnosis of sample made by 5 types. There were 31(62%) patients with encephalitis. The same data shown in Fig 4.2 h.
frequency
D IAG NOS
40 30 20 10 0
IS
frequency
4.2(h) Bar diagram of sample according to diagnosis
28
4.3 a Distribution of sample based on patients’ satisfaction about criteria information given by nurses.
In the questionnaire, criteria information given by nurses includes question no.1, 2, 3,4,5,10,18 and they are clubbed together.
Table 4.3a shows patient‟s satisfaction about information given by nurses.
Patient’s
satisfaction
about
Frequency
Percentage
Poor
1
2
Good
38
76
Excellent
11
22
Total
50
100
information given by nurses.
Table 4.3a shows that patient‟s satisfaction about information given by nurses. Only 2% samples rated poor. 38(76%) samples rated good and 11(22%) rated excellent.
INFORMATION GIVEN BY THE NURSES 38 40 30 11
20 10
frequency
1
0 poor
good
excellent
4.3a Bar diagram showing distribution of sample based on information given by nurses.
29
4.3b Distribution of sample based on patients’ satisfaction about information given by nurses and age group.
Table 4.3b Distribution of sample based on patients‟ satisfaction about information given by nurses and age group. The age of sample ranges from18-78 with a mean age of 44.7, standard deviation 16.88. Satisfaction of patient by information given
Age <45
Age ≥45
Total
Frequency
Frequency (%)
Frequency (%)
0
1 (2%)
16 (64%)
38 (76%)
9
(36%)
11 (22%)
25 (50%)
50 (100%)
by nurses
(%)
Poor
1
Good
(4%)
22 (88%)
Excellent
2 (8%)
Total
25 (50%)
Table 4.3b shows that patients with ≥45 years 64% rated good. Among that 36% rated excellent and no one reported poor. Among <45 yrs 88% were rated good, 2(8%) were rated excellent and only 4% were rated poor.
88%
100% 80%
64%
60%
age <45 36%
40% 20%
4%
age≥45
8%
0
0% poor
good
excellent
4.3b Bar diagram showing distribution of sample based on patients’ satisfaction about information given by nurses and age group
30
4.3c Distribution of sample based patients’ satisfaction about information given by nurses according to sex.
Table 4.3c shows distribution of sample based on patients‟ satisfaction about information given by nurses and sex
Satisfaction of the patient
Female
Male
Total
Frequency (%)
Frequency (%)
Frequency (%)
1
1 (2%)
Poor
0
(3.03%)
Good
13 (76.47%)
25 (75.76%)
38 (76%)
Excellent
4 (23.53%)
7 (21.21 %)
11 (22%)
Total
17 (100%)
33 (100%)
50 (100%)
Table 4.3c shows that majority of sample 38(76%) rated good, 22% rated excellent and only 2% were rated poor. Among females 13(76.47%) rated good, 23.53%rated excellent and no one reported poor. Among males and 25(75.76%) rated good, 21.21% were rated excellent and 3.03% rated poor.
25 20 15 female
10
male 5 0 poor
good excellent
Fig 4.3c Bar diagram shows distribution of sample based on patients’ satisfaction about information given by nurses and sex.
31
4.3d Distribution of sample based on patients’ satisfaction about information given by nurses and marital status
Table 4.3d shows distribution of sample based on patients‟ satisfaction about information given by nurses and marital status.
Satisfaction of
Single
Married
Total
Frequency (%)
Frequency (%)
Frequency (%)
Poor
0
1 (2.44 %)
1 (2%)
Good
7 (77.78 %)
31 (75.61%)
38 (76%)
Excellent
2 (22.22%)
9 (21.95%)
11(22%)
Total
9 (100 %)
41 (100 %)
50(100%)
patient
Table 4.3d shows that 22.22% rated excellent, 76% were rated good and 2% rated poor. Among single 77.78%rated good, 22.22% were rated excellent. Among married 21.95% rated excellent, 75.61% were rated good and only 2.44% rated poor. There is no relationship between marital status and information given by nurses. 35
31
30 25 20 single
15 10
9
5
married
1
0 poor
good excellent
. Fig 4.3d Bar diagram shows distribution of sample based on patients’ satisfaction about information given by nurses and marital status
32
4.3e Distribution of sample based on patients’ satisfaction about information given by nurses and educational status.
Table 4.3e shows distribution of sample based on patients‟ satisfaction about information given by nurses and educational status.
Satisfaction
School & plus2
Graduate & post
Total
of patient
Frequency (%)
graduate
Frequency (%)
Frequency (%) Poor
1 (2.70%)
0
1 (2%)
Good
27 (72.97%)
11 (84.62%)
38 (76%)
Excellent
9 (24.32%)
2 (15.38%)
11(22%)
Total
37 (100%)
13 (100%)
50 (100%)
Table4.3e shows that 22% were rated excellent.76% rated good and 2% rated poor. Among school &plus2 24.32% rated excellent, 72.97% rated good and 2.70% were rated poor. Among graduate &post graduate 22% excellent, 76% rated good and 2% poor. It means there is only a slight variation between educational status and information given by nurses.
30 25 20
school&plus 2
15 graduate &post graduate
10 5 0 poor
good
excellent
4.3e Bar diagram showing distribution of sample based on i nformation given by nurses and education
33
4.3f Distribution of sample based on patients’ satisfaction about information given by nurses and Income category.
Table 4.3f Distribution of sample based on patients‟ satisfaction about information given by nurses and income category
Satisfaction of patient
A
B1,B & C
D
Total
Frequency
Frequency (%)
Frequency
Frequency
(%)
(%)
(%) Poor
0
1(5%)
0
1
Good
2(66.67%)
17(85%)
19(70.37%)
38(76%)
Excellent
1(33.33%)
2(10%)
8(29.63%)
11(22%)
3(100%)
20(100%)
27(100%)
50(100%)
Total
Table 4.3f shows that among A category 33.33% rated excellent, among B1,B &C category 10 rated excellent and among D category 29.63% rated excellent. Among income category only 1% rated poor. There is no marked variation between income category and information given by nurses.
20 18 16 14 12
A
10
B1, B, C
8
D
6 4 2 0 poor
good
excellent
Fig 4.3f Distribution of sample by patients’ satisfaction about information given by nurses according to category
34
Table 4.3g Distribution of sample based on patients’ satisfaction about information given by nurses and to length of stay.
Table 4.3g Distribution of sample based on patients‟ satisfaction about information given by nurses and length of stay.
Satisfaction
of
≤10 days
>10 days
Total
Frequency(%)
Frequency(%)
Frequency(%)
Poor
1 (2.64%)
0
1(2%)
Good
31(73.68%)
7(83.33%)
38(76%)
Excellent
9(23.68%)
2(16.67%)
11(22%)
Total
41(100%)
9(100%)
50(100%)
patient
Table 4.3g shows that majority of sample ≤10days (73.68%) & among >10days (83.33%) were rated good. Among ≤ days 32.68% rated good and 2.64% rated poor. Among 10 days 16.67% rated excellent and no one rated poor.
35 30 25 20
≤10 days
15
>10 days
10 5 0 poor
good
excellent
Fig 4.3g Bar diagram shows distribution of sample based o n patients’ satisfaction about information given by nurses and length of stay
35
Table 4.3h Distribution of sample based on patients’ satisfaction about information given by nurses and previous admission.
Table 4.3h Distribution of sample based on patients‟ satisfaction about information given by nurses and previous admission.
Satisfaction of
Yes
No
Total
Frequency(%)
Frequency(%)
Frequency(%)
Poor
1(2.78%)
0
1(2%)
Good
26(72.22%)
12(85.71%)
38(76%)
Excellent
9(14.29%)
2(14.29%)
11(22%)
Total
36(100%)
14(100%)
50(100%)
patient
Table 4.3h shows that majority of samples 76% were rated good. Among previously admitted 14.29% & among previously not admitted 14.29% were rated excellent. It may be noted that there is no difference between information given by nurses and previous admission.
Chart Title 30 25 20 15
yes
10
no
5 0 poor
good
excellent
Fig 4.3h Distribution of sample based on patients’ satisfaction about information given by nurses and previous admission.
36
4.4a Distribution of sample based on criteria quality of nursing care
In the questionnaire , criteria quality of nursing care includes question no.7,8,9,11,12,13,14,15,16,17,19,20 and they are clubbed together
Table4.4a Distribution of sample based on quality of nursing care
Quality of nursing care
Frequency
Percentage
Good
34
68
Excellent
16
32
Total
50
100
Table 4.4a shows that 34(68%) samples were rated good.16 (32%) were reported excellent and no one rated poor.
QUALITY OF NURSINGCARE
good excellent
Fig4.4a shows distribution of sample according to quality of nursing care
37
4.4b Distribution of sample based on quality of nursing care and age.
Table 4.4b Distribution of sample based on quality of nursing care and age.
Quality
of
<45
≥45
Total
Frequency (%)
Frequency (%)
Frequency (%)
Good
17 (68%)
17(68%)
34(68%)
Excellent
8 (32%)
8(32%)
16 (32%)
25 (100%)
25 (100%)
50 (100%)
nursing care
Total
Table 4.4b shows that there is no relationship between age group and quality of nursing care.
18 16 14 12 10
<45 years
8
>=45 years
6 4 2 0 good
excellent
Fig 4.4b Distribution of sample based on quality of nursing care and age.
38
4.4c Distribution of sample based on quality of nursing care and sex.
Table 4.4c Distribution of sample based on quality of nursing care and sex.
Quality of nursing
Female
Male
Total
care
Frequency (%)
Frequency (%)
Good
11(64.71%)
23 (69.70%)
34 (68%)
Excellent
6 (35.29%)
10(30.30%)
16(32%)
Total
17(100%)
33(100%)
50 (100%)
Table 4.4c shows that among females and males majority rated good. 35.29% females and 30.30% males rated excellent. There is no marked relation between quality of nursing care and sex.
25 20 15 10 5 0 good
excellent
Fig 4.4c Distribution of sample based on quality of nursing care and sex.
39
4.4d Distribution of sample based on quality of nursing care and marital status.
Table 4.4d Distribution of sample based on quality of nursing care and marital status.
Quality
of
Single
Married
Total
Frequency(%)
Frequency (%)
Frequency (%)
Good
6 (66.67%)
28 (68.29%)
34(68%)
Excellent
3 (33.33%)
13 (31.71%)
16(32%)
9(100%)
41 (100%)
50(100%)
nursing care
Total
Table 4.4d shows that there is no marked variation between marital status and quality of nursing care. Among that 34(68%) were rated good and 16(32%) were excellent.
30 25 20 single 15
married
10 5 0 good
excellent
Fig4.4d Distribution of sample based on quality of nursing care and marital status.
40
4.4e Distribution of sample based on quality of nursing care and education.
Table 4.4e Distribution of sample based on quality of nursing care and education
Quality
of
School& plus 2
Graduate &post
Frequency (%)
graduate
Good
28(75.68%)
6 (46.15%)
34(68%)
Excellent
9 (24.32%)
7 (53.85%)
16 (32%)
Total
37(100%)
13 (100%)
50 (100%)
nursing care
Total
Table 4.4e shows that majority of the sample from school and plus2 were rated good 28(75.68%) and majority of the sample from graduate and post graduate rated excellent 7(53.85%).
30 25 20 school& plus 2 15 10
graduate& postgraduate
5 0 good excellent
Fig 4.4e Distribution of sample based on quality of nursing care and education
41
4.4f Distribution of sample based on quality of nursing care and income category
Table 4.4f Distribution of sample based on quality of nursing care and category
Quality
of
A
B1, B & C
D
Total
Frequency
Frequency
Frequency
Frequency
(%)
(%)
(%)
(%)
Good
1 (33.33%)
14(70%)
19(70.37%)
34(68%)
Excellent
2(66.67%)
6(30%)
8(29.63%)
16(32%)
3(100%)
20(100%)
27(100%)
50(100%)
nursing care
Total
Table4.4f shows that majority of sample from B1,B & C 70%, from D category 19(70.37%) rated good and majority of sample from A category 2(66.67%) were rated excellent.
20
15 A B1, B &C
10
D 5
0 good
excellent
Table 4.4f Distribution of sample based on quality of nursing care and category.
42
4.4g Distribution of sample based on quality of nursing care and length of stay
Table 4.4g Distribution of sample based on quality of nursing care and length of stay
Quality
of
≤10 days
>10
days
Total
nursing care
Frequency(%)
Frequency(%)
Frequency(%)
Good
29(76.39%)
5(41.67%)
34(68%)
Excellent
9(23.68%)
7(58.33%)
16(32%)
Total
38(100%)
12(100%)
50(100%)
Table 4.4g shows that among ≤10 days 29(76.39%) were rated good, 23.68% rated excellent and among >10 days 58.33% rated excellent 7(58.33%), 41.67% rated good.
30 25 20
<=10 days
15
>10 days
10 5 0 good
excellent
Fig 4.4g Distribution of sample based on quality of nursing care and length of stay.
43
4.4h Distribution of sample based on quality of nursing care and previous admission
Table 4.4h Distribution of sample based on quality of nursing care and previous admission
Quality
of
Yes
No
Total
Frequency (%)
Frequency(%)
Frequency(%)
Good
10(71.43%)
24(66.67%)
34(68%)
Excellent
4(28.57%)
12(33.33%)
16(32%)
total
14(100%)
36(100%)
50(100%)
nursing care
Table 4.4h shows that 10(71.43%) previously admitted samples and 24(66.67%) previously not admitted samples were rated good. 4 (28.57%) previously admitted and 12(33.33%) previously not admitted were rated excellent. There is only a slight variation between quality of nursing care and previous admission.
25 20 15
yes no
10 5 0 good
excellent
Fig 4.4h Distribution of sample based on quality of nursing care and previous admission.
44
4.5a Distribution of sample according to overall patient satisfaction with quality of nursing care.
Table 4.5a Distribution of sample according to overall patient satisfaction with quality of nursing care.
Overall patient
Frequency
Percentage (%)
Excellent
15
30
Good
35
70
Total
50
100
satisfaction with quality of nursing care
Table 4.5a shows that distribution of sample according to overall patient satisfaction with nursing quality of care. 15 (30% were rated excellent, 35(70%) were rated good and no one rated poor.
frequency 15 30%
excellent good
35 70%
4.5a Pie diagram shows distribution of sample by overall patient satisfaction with nursing care.
45
4.5b Association of overall patient satisfaction with quality of nursing care and selected variables. Table 4.5 b shows that association of overall Patient satisfaction with quality of nursing care and variables.
Different Variables
Patient Satisfaction
Total
P-value
0.031
Excellent
Good
(%)
(%)
<45
4(16%)
21(84%)
25(100%)
≥45
11(44%)
14(56%)
25(100%)
Male
12(36.36%)
21(63.64%)
33(100%)
Female
3 (17.65%)
14(82.35%)
17(100%)
Single
4(44.44%)
5(55.6%)
9(100%)
Married
11(26.8%)
30(73.2%)
41(100%)
11(29.7%)
26(70.3%)
37(100%)
4(30.7%)
9(69.3%)
13(100%)
1(33.3%)
2(66.7%)
3(100%)
5(25%)
15(75%)
20(100%)
9(33.3%)
18(66.7%)
27(100%)
13(30%)
28(70%)
41(100%)
Age
Sex
0.148
Marital status
0.25
Education School &plus2 Graduate&
0.602
postgraduate Income category A B1,B &C D
0.88
Length of stay ≤10 days
46
0.493
>10 days
2(23.2%)
7(77.8%)
9(100%)
10(27.8%)
26(72.2%)
36(100%)
Previous admission Yes
0.40
No
5(35.7%)
9(64.3%)
14(100%)
Table 4.5 b shows overall patient satisfaction with quality of nursing care.
Table 4.5 b shows that age<45 excellent (16%), good (84%) and age ≥45 excellent (44%), good (56%) (P-value 0.031) it shows statistically significant relation between age group and patient satisfaction with quality of nursing care. Male36.6% were excellent, 63.64%were good and female 17.65% were excellent, 82.35%were good (p-value 0.05) shows statistically no significant relation between sex and patient satisfaction. Married 26.8%were excellent, 73.2% were good and single 44.4% were excellent, 55.6% were good (p-value 0.25) shows statistically no significant relation between marital status and patient satisfaction. In School &plus2 29.7% were excellent, 70.3% were good and graduate and post graduate 30.7% were excellent ,69.35% were good(p-value 0.602) shows statistically no significant relation
between
education
and
patient
satisfaction.
Income
category
A
category33.3%were excellent, 66.7% were good, category B1 B C 25% were excellent 75% were good, D 33.3% were excellent, 66.7% were good( p-value0.88) there is no significant relation between income category and patient satisfaction. According to length of hospital stay ≤10 days 30% were excellent, 70% were good and>10 days 23.2% were excellent, 77.8% were good (p-value0.493) there is no significant relation with length of stay and patient satisfaction. According to previous admission 27.8% were excellent, 72.22% were good and previously not admitted 35.7% were reported excellent , 64.3% were good (p- value 0.4) there is no significant relation between patient satisfaction and previous admission.
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Chapter - V
SUMMARY, CONCLUSION, LIMITATION, DISCUSSION AND RECOMMENDATION 5.1 Introduction This chapter gives a brief account of the present study including conclusion drawn from the findings and possible application of the results. Recommendations of the further research and suggestion for improving the present study are also presented.
5.2 Summary This study was undertaken to assess patient satisfaction with quality of nursing care
The experience in neuromedical unit in Sree Chitra Tirunal Institute for Medical Science and Technology motivated the investigator to undertake this study of Patient Satisfaction with nursing care. The review of related literatre helped the investigator to get a clear concept about research topic. For this study a modified form of Dr. Laschinger‟s-
“Patient satisfaction with quality nursing care
questionnaire” [PSNCQQ], was used. PSNCQQ translated to vernacular language Malayalam. Data collection was done from the month of August 2011 to October 2011, analyzed and interpreted using descriptive and inferential statistics .
5.3 Objectives of the study The specific objective of this study:1.
To assess the patient satisfaction with quality of nursing care.
2.
To identify relationship between satisfaction of patient with selected variables
5.4 Limitation * Patients who can read and understand Malayalam * The Sample size limited to 50
48
*Patients who have age above 18 years. *The study was limited to neuromedical unit.
5.5 Major findings of the study Total number of sample was 50. The mean age of patients was 44.7 yrs, standard deviation 16.88. Patient satisfaction with quality nursing care <45 ranges from excellent 4(16%) and good 21(84%), ≥45 ranges from excellent 11(44%) and 14(56%).By doing unpaired t- test (p-value 0.031) there is statistical difference in patient satisfaction with nursing care with regard to age and no statistical difference in patient satisfaction with sex, marital status, education, income category, length of stay and previous admission.
5.6 Recommendations The following recommendations were made for f uture research. 1.
Similar study would be repeated in other intensive care units and
wards of this institute. 2.
Similar study can be repeated by increasing the size of the sample.
5.7 Discussion There are many studies related to Patient‟s Satisfaction with Nursing Care. Patient satisfaction is the popular way of evaluation nursing practice in most countries. The aim of the study was to assess the patient satisfaction with quality of nursing care and to identify relationship between satisfactions of patient with selected variables. The present study emphasized to assess patient satisfaction with quality of nursing care using Dr. Laschingers PSNCQQ by using excellent, good, and poor. In this study questionnaire include specific issue that affect satisfaction patient including comfortable feeling to talk to nurse. Foss[ 2002] conducted a study on Gender-related differences in experience with nursing care. The patient satisfaction questionnaire consisted of 39 questions (24). Thirty-four of the 39 questions had five response options, where the two extremes were specified (completely content – complete discontent). Six of the questions related to patient's experiences with nursing care. The overall response rate was 59%. Mean score of satisfaction with the
different areas of quality of nursing care (all ages) the
49
following
levels
of
significance;
personal
commitment = 0.003,
caring
behavior = 0.001, time to talk = 0.004, time to help = 0.000, nursing skills = 0.006. The patients' experiences with the continuity of care did not show significant gender difference (p = 0.117). No significant differences were found between the sexes in mean age in any of the three groups. »Milutinović D et al., (2012) The patient satisfaction with nursing care quality: the psychometric study of the Serbian version of PSNCQ questionnaire This cross-sectional study included a sample population of 240 patients. The PSNCQQ was translated into Serbian according to standard procedures for forward and backward translat ion Cronbach‟s α coefficient and item analysis was conducted to evaluate reliability of the scale. Results of the study was the Serbian version Patient Satisfaction Nursing Care Quality Questionnaire (PSNCQQ) showed a one-factor structure, Cronbach‟s α reliability coefficient was excellent 0.94 and was similar across hospital categories. The correlation coefficient between 19 items and the total scale was high, and ranged from 0.56 to 0.76. Patients‟ age, educational level and previous hospitalization peri od were important factors that affected their satisfaction with nursing care.
This study showed 76%patients reported information given by nurses was good and 68 %patients reported quality of nursing care was good. 70% patients reported overall nursing care was good and 30% were reported excellent. And there is no significant relation between satisfactions of patient with selected variables except age group, there is statistical difference in patient satisfaction and quality of nursing care (p-value0.031). To validate f inding more samples are needed.
5.8 Conclusion A descriptive study was undertaken to assess the Patient Satisfaction with Quality of Nursing care in neuromedical department in SCTIMST, Trivandrum. The study was conducted in sample of 50 patients. Based on the finding of the study the following conclusion was drawn. Study shows that 70% patients‟ rated overall patient satisfaction with quality nursing care was good and 30% were rated excellent and no one rated poor. There was statistically significant relation between age and satisfaction of patient (p-0.031) and no relation between other variables.
50
REFERENCE
Abramowitz S, Berry E, Cott A A. „Analyzing patient satisfaction; A multi analytic approach.‟ Quality review bulletin 1987; 13: 122-130.
Andaleeb S „Service quality and patient satisfaction, A study of Hospitals in a developing country.‟ Soc Sci Med 2011; 52:1359 -70.
Chang et al. „Evaluating quality of nursing care: The gap between Theory and Practice.‟ The Journal of nursing administration 2002; 32 (7/8) :405-18.
Chang E, Hancock K, Chenoweth L, Jean C. “The Influence of demographic variables and type on elderly patient‟s perception of need and satisfaction during hospitalization”. International Journal of nursing practice 2003; 9 [3]: 191-201.
Erickson L R. „Patient satisfaction: -an indicator of nursing care quality.‟ J nurse management 1987; 18: 31-35.
Fahad A F. „The effect of nursing care on overall patient satisfaction and its predictive value on return-to-provider behavior. A survey study.‟ Quality management in health care 2005; 14 [2]: 337-44.
Findik U Y and Unsar S „Patient satisfaction with nursing care and its relationship with patient characteristics.‟ Nursing and Health Sciences 2010; 12 [2]:162-69.
Foss C. „Gender bias in nursing care? Gender – related in patient satisfaction with quality of nursing care‟. Scandinavian journal of caring nurses 2002; 16 [1]: 19-26.
Harkreader H & Hogan M A. „Fundamentals of nursing caring & clinical judgement‟ . Elsiver science 2004;2: 45-51.
51
Ijeoma M, Ada N, Peace I, Akpati V . „Helpless patient satisfaction with quality of nursing care in federal territory hospitals, Enugu, Southeast, Nigeria.‟ International journal of nursing and midwifery 2011; 3 [1]:6-13.
Johansson P, Oleni M, Fridlund B. „Patient satisfaction with nursing care in the context of health care: Literature study‟. Scandinavian journal of caring nurses 2002; 16 [4]: 337-44.
Laschinger H S. „A psychometric analysis of patient satisfaction with nursing care quality questionnaire: an actionable approach to measuring patient satisfaction.‟ Journal of nursing care quality 2005; 20 [3]; 220-30.
Laschinger H S, Hall L M, Pederson S, Almost J. A psychometric analysis of patient satisfaction with nursing care quality questionnaire; an actionable approach to measuring patient satisfaction‟. J Nurse Care quality 2005; 20: 220-230.
Lindgren M, Andersson I S. „The Karen instrument for measuring quality of nursing care: construct validity and internal consistency.‟ International journal for quality in health care 2011; 17:115-20.
Lucero R J, Lake E T, Aiken L H. „Nursing care quality and adverse events in U S hospitals‟. Journal of clinical nursing 2010; 19 [15,16]:2185-95.
Lynn M R, Mcmillen B J, Sidani S. „Understanding and measuring patient assessment of quality of nursing care‟. Nursing Research 2007;56 [3]: 15966.
Merkouris A, Ifantopoulos J, Lanarva v,Lemonidou C. „patient Satisfaction: a key concept for evaluating and improving nursing service‟. J Nurs Manag 1999; 13:19-22.
52
Mrayyan M T. „Jordanian nurses job satisfaction, patient‟s satisfaction and quality of nursing care‟. Int Nurs Revn 2006; 53[3]: 224-30.
Muntlin A, Gunningberg L, Carlsson M. „ Patient‟s perception of care at an emergency department and identification of areas for quality Improvement.‟ J Clin Nurs 2006; 15[8]: 1045-56.
O‟Connel B, Young J, Twigg D. „Patient satisfaction with nursing care: A measurement conundrum.‟ International Journal of Nurs ing Care Practice 2002; 5[2]: 72-77.
Risser N. „Development of instrument to measure patient satisfaction with nurses and nursing care in primary care setting‟. Nursing Research 1975 ; 24: 45-52.
Uys L R & Naidoo J R. „A survey of quality nursing care in several Health districts in South Africa‟. B M C nursing 2004; 3:22-38.
Wagner D and Bear M. „Patient satisfaction with nursing care: a Concept analysis within a nursing framework‟. Journal of advanced Nursing 2009; 65: 692-701.
Yi M, Kim J, Noh D, Lee J L, Yoo K Y, Hwang K, Chung H. „Evaluation of satisfaction and usefulness of web based educational program for breast cancer patient.‟ Open Med Inform Journal 2008;2: 129-37
Yildirim C, Kocoglu H, Goksu S, Gunay N, Savas S. Patient Satisfaction in a university hospital emergency department in Turkey.‟ Actamedica 2005; 48[1]: 59-62.
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INFORMED CONSENT I hereby agree to participate the research study “A study to assess Patient Satisfaction with Quality of Nursing Care” conducted by Mrs. st
Rajeswari T 1 year Diploma in Neuro Nursing of SCTIMST, Trivandrum. I understand that there will not be any change in the nature of care that I receive and data given by me will be kept confidential and will be used only for research purpose.
Signature of patient, Name: Place: Date:
54
PATIENT SATISFACTION WITH NURSING CARE QUALITY QUESTIONNAIRE (Laschinger, McGillis Hall, Pedersen & Almost, 2005)
Please rate some things about the nursing care during your hospital stay in terms of whether they were Excellent, Very Good, Good, Fair or Poor. Please check only one rating for each statement.
Very Excellent
Good
Good
Fair
Poor
about your condition and needs.
INVOLVING FAMILY OR FRIENDS IN
INFORMATION YOU WERE GIVEN:
How
clear
and
complete
the
nurses’
explanations were about tests, treatments, and what to expect. INSTRUCTIONS:
How
well
nurses
explained how to prepare for tests and operations. EASE OF GETTING INFORMATION:
Willingness
of
nurses
to
answer
your
questions.
INFORMATION GIVEN BY NURSES:
How well nurses communicated with patients, families, and doctors.
INFORMING FAMILY OR FRIENDS:
How well the nurses kept them informed
55
YOUR CARE: How much they were allowed
to help in your care.
CONCERN AND CARING BY NURSES:
Courtesy
and
respect
you
were
given;
friendliness and kindness.
ATTENTION OF NURSES TO YOUR CONDITION: How often nurses checked on
you and how well they kept track of how you were doing.
RECOGNITION OF YOUR OPINIONS:
How much nurses ask you what you think is important and give you choices.
CONSIDERATION OF YOUR NEEDS:
Willingness of the nurses to be flexible in meeting your needs. THE
DAILY
ROUTINE
OF
THE
NURSES: How well they adjusted their
schedules to your needs.
Very Excellent
Good
Good
Fair
Poor
HELPFULNESS: Ability of the nurses to
make you comfortable and reassure you. NURSING STAFF RESPONSE TO YOUR CALLS: How quick they were to help.
SKILL
AND
COMPETENCE
OF
NURSES: How well things were done, like
56
giving medicine and handling IVs.
RESTFUL ATMOSPHERE PROVIDED BY NURSES: Amount of peace and quiet.
PRIVACY: Provisions for your privacy by
nurses.
DISCHARGE
INSTRUCTIONS:
how
clearly and completely the nurses told you what to do and what to expect when you left the hospital.
COORDINATION
OF
CARE
AFTER
DISCHARGE: Nurses’ efforts to provide for
your needs after you left the hospital. OVERALL PERCEPTIONS
Very Excellent
Good
Good
Fair
Poor
during your hospital stay.
In general, would you say your health is:
Strongly
Somewhat
Somewhat
Strongly
agree
agree
Agree
disagree
disagree
Overall quality of care and services you received during your hospital stay
Overall quality of nursing care you received
Based on the nursing care I received, I would recommend this hospital to my family and friends GENERAL
57
Gender:
Male
Female
Age in years: _______ years
Marital Status: Single Married/Cohabiting Separated/Divorced Widowed Including this most recent hospital stay, how many times were you (the patient) hospitalized in the past 2 years?
Only
once
Twice 3
Times
4
Times
Over
4 Times
Overall, how would you rate your (the patient’s) health before this most recent hospital stay? Excellent Good
Fair
Were
you:
Department
Admitted
Poor
through
Very
the
Poor
Unsure
Emergency Transferred
from another facility
Admitted through patient registration/to Other
the unit directly Admitted
after day procedure or test
For most of your hospital stay, were you in a room: By
yourself
Please
With
1 other person
With
more than 1 other person
check here if someone other than the patient completed this survey.
THANK YOU FOR TAK ING THE TIME TO FILL OUT THIS SURVEY.
58